后交通动脉瘤性动眼神经麻痹的预后影响因素分析

Analysis of prognostic factors on posterior communicating artery aneurysm caused oculomotor nerve palsy

目的 探讨并分析后交通动脉瘤性动眼神经麻痹预后的影响因素.方法 回顾性分析2006年5月至2009年5月治疗的23例伴有动眼神经麻痹的后交通动脉瘤患者临床及随访资料.其中男性7例,女性16例,年龄32～74岁,平均50.4岁.10例选择开颅动脉瘤夹闭术（夹闭组）,13例选择动脉瘤栓塞术（栓塞组）.结果 随访2年,栓塞组6例彻底恢复、7例部分恢复；夹闭组6例彻底恢复、4例部分恢复；两组动眼神经麻痹预后差异无统计学意义（P =0.407）.术前部分动眼神经麻痹患者相对于完全动眼神经麻痹患者,彻底恢复的比例高,但差异无统计学意义（P =0.095）.发病至手术治疗间隔时间≤14 d的患者比＞14 d再进行手术治疗的患者动眼神经麻痹症状改善明显（P =0.045）.结论 在治疗伴有动眼神经麻痹的后交通动脉瘤患者时,经血管内动脉瘤栓塞术与开颅动脉瘤夹闭术比较,在改善动眼神经麻痹方面无显著差异,发病至手术治疗间隔时间是较明确的影响动眼神经麻痹预后因素.

Objective To study and analyze the factors affecting the recovery of posterior communicating artery aneurysm-induced oculomotor nerve palsy（ONP）.Methods The clinical and follow-up data of posterior communicating artery aneurysm-induced ONP in 23 patients from May 2005 to May 2009 were retrospectively compared.There were 7 male and 16 female with a meanage of 50.4 years.Among the 23 patients,13 patients underwent endovascular coiling（endovascular group）and 10 patients underwent surgical clipping（surgical group）.Results Of the patients with 2 year of follow-up,6 patients recovered completely and 7 patients recovered partially in the endovascular group,compared with 6 patients recovered completely and 4 patients recovered partially in the surgical group（P =0.407）.Compared to the patients with preoperative complete ONP,the rate of complete recovery was higher in the patients with preoperative partial ONP,while the results did not reach the significance（P =0.095）.Patients accepted treatment in 14days since the onset of symptoms recovered significantly than who accepted treatment after 14 days since the onset of symptoms（P =0.045）.Conclusions There is no significant difference in recovery from ONP between endovascular coiling and surgical clipping as treatment for posterior communicating artery aneurysm patients with ONP.Timing of treatment after onset of symptoms is a factor affects the recovery of ONP.